Vignon Philippe, Charron Cyril, Legras Annick, Musset Frédérique, Slama Michel, Prat Gwenaël, Silva Stein, Vandroux David, Müller Grégoire, Levy Bruno, Boissier Florence, Evrard Bruno, Goudelin Marine, Mankikian Stéfan, Nay Mai-Anh, Jabot Julien, Riu Béatrice, Bailly Pierre, Maizel Julien, Léger Julie, Vieillard-Baron Antoine
Medical-Surgical ICU, Dupuytren University Hospital, Réanimation Polyvalente, CHU Dupuytren, Limoges, France.
Inserm CIC 1435, Dupuytren University Hospital, Limoges, France.
Intensive Care Med. 2025 Jan;51(1):94-105. doi: 10.1007/s00134-024-07748-2. Epub 2025 Jan 7.
Prognostic impact of left ventricular diastolic dysfunction (LVDD) in septic shock patients has not been determined using current diagnostic guidelines. We assessed the relation between LVDD during the first 3 days following intensive care unit (ICU) admission for septic shock and Day-28 mortality.
This prospective, multicenter, observational study enrolled 402 patients (age: 63 ± 13 year; 59% male; SAPS II: 59 ± 20; SOFA: 9.4 ± 3.6; mechanical ventilation: 74%) with septic shock (Sepsis-3 definition). Patients were echocardiographically assessed within 12 h after admission (Day 1), on Day 2, Day 3, at ICU and at hospital discharge (or Day 28 whichever occurred first), using 2016 American-European guidelines.
LVDD was present at least once between Day 1 and 3 in 304 patients (76%), and in 56% and 44% of patients at ICU discharge and on Day 28 (or hospital discharge), respectively (43% of patients with follow-up). Seventy-eight of 172 patients (45%) exhibited similar LV diastolic properties throughout the study period while 58 patients (34%) improved their LVDD at follow-up (lower grade: n = 9, regression: n = 49). Day-28 mortality was not statistically different between patients with and without LVDD (80/304 [26%] vs. 25/88 [28%]; OR: 0.900 [0.530-1.527]; p = 0.696). Similar results were obtained when adjusting the multivariate model on SAPSII or SOFA score on admission, together with fluid balance during the first three days of ICU stay (OR: 0.838 [0.471-1.491]: p = 0.547 and OR: 0.887 [0.513-1.534]: p = 0.668, respectively).
LVDD was highly prevalent in patients with septic shock but not associated with mortality. It appeared improving in one-third of survivors.
PRODIASYS study registered on ClinicalTrials (September 27, 2016, number NCT02918214).
目前的诊断指南尚未确定左心室舒张功能障碍（LVDD）对感染性休克患者预后的影响。我们评估了感染性休克患者入住重症监护病房（ICU）后前3天内的LVDD与第28天死亡率之间的关系。
这项前瞻性、多中心、观察性研究纳入了402例感染性休克患者（脓毒症-3定义），年龄63±13岁，男性占59%，简化急性生理学评分（SAPS II）为59±20，序贯器官衰竭评估（SOFA）为9.4±3.6，机械通气率为74%。患者在入院后12小时内（第1天）、第2天、第3天、ICU出院时和出院时（或第28天，以先到者为准）接受超声心动图评估，采用2016年美国-欧洲指南。
304例患者（76%）在第1天至第3天期间至少有一次出现LVDD，在ICU出院时和第28天（或出院时）分别有56%和44%的患者出现LVDD（随访患者的43%）。172例患者中有78例（45%）在整个研究期间表现出相似的左心室舒张特性，而58例患者（34%）在随访时LVDD有所改善（等级降低：9例，恢复正常：49例）。有LVDD和无LVDD的患者第28天死亡率无统计学差异（80/304 [26%] 对25/88 [28%]；比值比：0.900 [0.530 - 1.527]；p = 0.696）。在对入院时的SAPSII或SOFA评分以及ICU住院前三天的液体平衡进行多变量模型调整后，得到了类似的结果（比值比分别为：0.838 [0.471 - 1.491]：p = 0.547和0.887 [0.513 - 1.534]：p = 0.668）。
LVDD在感染性休克患者中非常普遍，但与死亡率无关。三分之一的幸存者中LVDD似乎有所改善。
PRODIASYS研究已在ClinicalTrials注册（2016年9月27日，编号NCT02918214）。
